User’s guide - ETK · temporomandibular joint disorder an insufficient restorative space if a sinus lifting is needed with the implant a patient presenting risks (patient exposed

User’s guide

Surgery and Prothesis

2

3

Introduction

is the result of 23 years of clinical applications and 27 years of research and development confirmed by valuable help of international research laboratories.

The design of our implants is based on the skills of our teams which are both reactive and experienced in implantology:

Technical and biomechanical skills of our engineers enabling to guarantee the resistance of the component andtheir adaptation to the oral environment thanks to modern means of simulation.

Biological and physiological skills of the associated laboratories enabling to validate the capacity of osseointegration of our systems.

Clinical and practical skills of our dentists advisers ensuring the ergonomics of our products, the confirmation of our protocols and the ranges adapted to the various clinical cases.

Aesthetica+2 implants are relied on the most new advanced scientific knowledge regarding implant treatment, which provides this implant an optimal capacity of anchoring with a strong osseointegration, in particular in the cortical bone area.

To enable you to take the best advantage of the Aesthetica+2 implant, we created this manual with a professional care. We invite you to read it with your best attention. Each detail, even the least important, has its importance and underlines even more the difference between the beginner and the specialist.

4

5

Warning p. 6

General information p. 7 to 9

Pre-implant study p. 11 to 14

Surgical procedure p. 15 to 39

FOREWORD P. 16AESTHETICA+2 IMPLANT P. 18THE KIT P. 22PROTOCOL

by bone density and implant diameter P. 24step by step P. 26

Impression techniques p. 35 to 39WITH PICK-UP IMPRESSION COPING P. 37WITH POP-IN IMPRESSION COPING P. 38WITH POP-UP IMPRESSION COPING P. 39

Prosthetic procedure p. 40 to 62

FOREWORD P. 42CEMENTED PROSTHESIS

abutment choice P. 43on trans-screwed abutment P. 45on Direct Clip abutment P. 49

ZIRCONIA PROSTHESISon Esthetibase interface P. 55

SCREWED PROSTHESISon ConOcta abutment P. 59

OVERDENTUREon O’Ring abutments P. 61

Summary

For more information on ,

implants, please visit our complete internet website,

www.etk.dental

6

Warning

The placement of implants must be done by a practioner who has been previously trained for the dental implantology techniques and in aseptic conditions specific to this type of treatment.

The following instructions will guide you throughout the different stages of your implantology treatments. They contain advice as precise as possible but cannot be used as «recipes», every clinical situation must be evaluated for each patient. A great number of factors acts independently to obtain success in an implantology treatment. It is up to the practioner to recognize the key factors and to use his clinical experience. Among other aspects, the coordination between the prosthesis laboratory dental technician and the practioner must be perfect so as to give the global treatment plan more consisting. Only the practioner remains responsible for his different choices and decisions as to the treatment’s feasibility, implants, prosthetic parts, materials used and settings... The technical specifications and clinical advice in this manual are given solely as a guideline and cannot give rise to any claims. All the essential information is indicated in the instruction for use supplied with products.

We have taken great care in the design and production of our products. However, we reserve the right to bring modifications or improvements arising from new technical developments in our implantology system.We will advise of any modifications having an implication in the operation mode. According to the importance of the modifications, a new manual will be issued. Indeed, a mark on the back page indicates the date of issue of your surgery manual, and enables us to check if you have the latest update version. You will also be able to access our web site to check the latest version of this manual.

The reproduction and distribution of all or part of this manual need previous agreement from .

7

GENERAL INFORMATION

8

Aesthetica+2 implant GENERAL INDICATIONS

Specific indications for 6 mm LONG IMPLANTS

The implant Aesthetica+2 is a transgingival implant designed to be placed in one step surgery; its characteristics provide great primary stability and may allow for immediate loading.

Contra indications to the use OF THE IMPLANTS (REMINDER)

Guarantee

Lack of retention of a prosthesis Instability of a prosthesis Functional discomfort with the prosthesis Psychological refusal of the wearing of a prosthesis Parafunctional practices which compromise the

stability of a prosthesis Inadequate localization and number of remaining

abutments

Lack of dental abutment to perform a fixed prosthesis

Edentulous area with healthy adjacent teeth Request for a treatment preserving the adjacent

healthy teeth Dental agenesis Request for a preservation treatment (refusal of

alteration of healthy teeth)

Absolute contra indications

severe medical diseases bone metabolism disorders uncontrolled hemorrhagic disorders healing disorders major psychological disorders functional disorders risky cardiopathy incomplete maxillary and mandible growth uncontrolled systemic pathology (endocrine diseases,

xerostomy, allergy to titanium)

infectious, hematological and immune pathology (immune disorder)

alcoholism, medication or drug addiction, regular steroid use)

patients with little motivation or cooperation age of the patient (young patient during growth) poor hygiene of the patient

As the anchorage surface of these implants is limited, they should be used only for the following indications: as complementary implants to longer implants in a multi-unit restoration, to support full prosthesis, in case of a very atrophied mandible, on implant sites of a bone quality higher to D4 according to the Misch classification.

Relative contra indications

use of anticoagulants, hemorrhagic diathesis Insufficient volume and / or an osseous quality a poor oral hygiene temporomandibular joint disorder an insufficient restorative space

if a sinus lifting is needed with the implant a patient presenting risks (patient exposed to atomic

radiation, bruxism, uncontrolled parodontitis, addiction to smoking)

General INFORMATION

In case of non osseointegration, you must inform your commercial representative so that we can examine the causes for the failure and bring the necessary corrective actions. An exchange may take place when the defect of the product is established; if the failure results from an incorrect clinical analysis, a surgical protocol not adapted to the case, from the use of blunt drills...or for any other reason independant from the product quality, the guarantee will not be taken into consideration.

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!

Euroteknika

Implant NATEA+

(Titane)

Made in France

41 42 Lg 12 mmøNATEA+ Implant 41 42 Lg 12 mmø!

NIDP 41 42 120

SB12101218632012.10 2017.10 04

99

Lot

Bat

chR

ef

25kGy mini.

natea

Euroteknika

Implant UNEVA+

(Titane)

Made in France

41 42 Lg 12 mmøUNEVA+ Implant 41 42 Lg 12 mmø!

UHDP 41 42 120

SB12101218632012.10 2017.10 04

99

Lot

Bat

chR

ef

25kGy mini.

Ø 06 X 12

Ø 06 X 12

Ø 06 X 12

AIEP 41 42 120

UHDP 06 62 120

UHDP 06 62 120

Euroteknika

Implant AESTHETICA+2

(Titane)

Made in France

41 42 Lg 12 mmøAESTHETICA+2 Implant 41 42 Lg 12 mmø

!

AIEP 41 42 120

SB12101218632012.10 2017.10 04

99

Lot

Bat

chR

ef

25kGy mini.

aesthetica 22

Parts PACKAGING

Storage OF THE PRODUCTS

Sterility and rule of asepsis

Most of our parts are delivered sterile and can therefore be used straightaway. A reference indicator shows the components effective sterility on the packaging. The sterility is guaranteed for 5 years (from packaging date). A standard expiry date is indicated on the label.

Only an undamaged packaging can guarantee the products imperviousness and sterility. Do not use implants with packaging which has been damaged or prematurely opened.

Our products have been designed so as to enable handling without affecting their sterility. It is therefore important to follow a precise handling technique so as

not to compromise the conventional hygiene conditions associated with the implant practice.

The non-sterile instruments and items delivered used for the implantology treatment must be decontaminated and, according to a tested process, sterilized at the practice.

Precautionary MEASURES

It is strongly advised to keep in stock, implants which cover the most frequently used diameters as well as the different lengths.It is important to be able to change an implant’s choice during a procedure, to replace an implant which has been contaminated for any reason, to insert an extra implant in certain cases to insure the long term treatment success...

We recommend the use of a safety system (floss attached to instruments or a suitable throat protection system) on the instruments in case of accidental dropping of tools in the patient’s throat.

It is strongly advised to put in place the receiving socket with instruments shown in this manual.

The implants must be stored in a clean, dry and cool place.

Sterile No sterile

Implants xHealing abutment(Supplied with Implant)

x

Drills x

Be careful see detailed description

Don’t use if the packing is damaged

Manufacturing

Complying with European requirements directives regarding medical plan 93/42 CEE

Date of manufacturing

Sanitation method using radiation

Store in a dark place

Store in a dry place

Use until

Don’t reuse

See the instruction manual

Product reference number

Serial numberDon’t sterilize twice

Labels

Our implants are delivered with 2 principal labels and one removable label clearly showing the mark, the reference and the batch number (for a total of 3 labels):

2 labels for the patient’s file of the practioner who placed the implant and/or of the correspondent.

1 label for the patient.

QR code for rapid and simple access to the user manual

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11

PRE-IMPLANTSTUDY

12

IMPLANT treatment feasibility

A patient’s questionnaire to reveal potential health/medications problems which could have a bearing on the treatment success, alcohol, use tobacco or drugs, general dental hygiene...

An oral examination which will give details about the mouth opening, the ligne of the patient’s smile (if is it a gingival smile), the coronary height and the volume of bone available, the type of occlusion...

Biological tests (glycemy...)

A complete X-Ray file showing the available bone’s volumes

Complete tests studies with the two dental arches in occlusion.

An implant treatment cannot be started without a thorough cleaning of all the patient’s infectious seats.

This study takes different elements into consideration

Guide for the IMPLANTS CHOICE

Available bone volume

In the mesio-distal plan

Leave 2 mm between the implant’s thread and natural teeth.

Leave 3 mm between the thread of two implants. Leave necessary space to fit the implant’s collar

(Ø 4.8 or 6.5).

In the labio-lingual palatal direction

Leave, if possible, 1.5 to 2 mm of bone thickness around the labial, palatal & lingual surfaces.

Bone quality

It is recommended to, use larger implants in low density bones to compensate the loss of surface contact bone/implant due to sockets.

Bon

e qu

ality

It is necessary to evaluate the possibility of an implantology treatment and to determine the treatment plan.Pre-implant STUDY

1 : very high density of compact bone 2 : thick layer of cortical bone around a dense core of spongious tissue 3 : thin layer of cortical bone around a big core of spongious tissue4 : thin layer of cortical bone around a big core of low density of spongious tissue

The classification of osseous structures*

A : important quality of remaining alveolar boneB : limited resorption of the alveolar bone crestC : important resorption of the alveolar bone crestD : beginning of the basal resorption boneE : important resorption of the basal bone

* Misch, (1998) Lekholm and Zarb (1985), Classification of partially edentulous arches for implant dentistry.

Recommended length

D1 6 - 8 mm

D2 10 mm

D3 12 mm

D4 12 mm

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8 8 5 5 5.5

5 7.5

8 9 5 5 5.5 4 3.5

8 8 5 5 5.5

5 7.5

8 9 5 5 5.5 4 3.5

Caption

= platform Ø 4,2

= platform Ø 4,8

= platform Ø 6,5

Implant Ø 3,6

Implant Ø 4,1

Implant Ø 4,8

Mesio distallength of themaxillar teeth

Implants Ø

Implants Ø

YES YESNO

Mesio distallength of themandibular teeth

The implant platform must be, ideally, slightly smaller than the prosthetic crown to insure the widening of the soft tissues and the prosthesis emergence. The ratio crown height/implant length must always be below 1.

A molar replacement must be done with either 2 implants of small diameters or with an implant of large diameter so the support cusps are located in the implant’s axis (better distribution of the forces on the bone ).

Dimensions of the crown and occlusal loads

Maxillar

Mandible

14

Use OF THE SURGICAL TRANSPARENCIES

In order to guide the choice of the implant in terms of length and diameter, has developed surgical transparencies that show the dimensions of its different implants. Thereby, the implants are represented with 1:1, 1.3:1 and 1.7:1 magnifications (magnifications correspond to the usual magnifications of the different types of medical imaging systems: retroalveolar X-ray, X-ray dental panoramic and tomography analysis SCANORA, CBCT (Cone Beam).

When the practitioner accurately knows the magnification of the pre-surgical X-ray, and if this magnification is 1:1, 1.3:1 or 1.7:1, by a simple superposition of the corresponding template (1:1 template for a 1:1 magnification, 1.3:1 template for a 1.3:1 magnification and 1.7:1 template for a 1.7:1 magnification), it is possible to determine which type of implant can be placed in the available bone volume.

When the practitioner does not know the magnification of the X-ray or to avoid any mistakes, he may place a reference object with known dimensions in the mouth of the patient when performing the X-ray examination in order to determine the associated magnification :

The real dimensions of the reference object shall be known to a minimum accuracy of ± 15µm. The reference object shall be held in position using wax for example or by embedding the object in a partial impression. Care should be taken for the patient not to swallow the reference object. Use a safety thread if the geometry of the reference object allows it.

Then, if the calculated magnification is 1:1, 1.3:1 or 1.7:1, you may use the transparencies.

In all cases, if the magnification is not 1:1, 1.3:1 or 1.7:1, it is not possible to use the transparencies provided by the but the bone volume may be determined thanks to proportionality calculation using the X-ray and the measured

magnification.

In this pre-implantation phase the practitioner must also design the coming prosthetic construction since implantology must be considered as a prostheticaly driven project. Indeed, pre-prosthetic planning and surgical planning are closely linked and any change to one will have consequence on the other. It is during this phase that we may determine the number of implants, their diameters, their lengths, their locations and their orientations in order that we may proceed with the planned prosthetic construction.

Magnification =dimensions of the reference object measured on the radiograph

real dimensions of the reference object

Pre-implant STUDY

15

SURGICALPROCEDURE

aesthetica 22

16

For all the euroteknika implants, the preparation of the implant site is carried out in 3 steps: 1. Initial preparation of the implant site (marking of the bone and first drilling)2. Calibration of the implant site (bores, drillings and/or tapping)3. Implant placement (picking-up, screwing, stabilization and suture)

Warnings

Treatment planning and placement of dental implants require specific considerations. Practitioners are recommended to take practical training in order to learn proper techniques, including biomechanical requirements and radiographic evaluation.

Improper techniques in either implant placement or restoration can result in implant failure and significant loss of surrounding bone. Drilling sequences to place implants refer to a specific depth measurement and to unique reference points for each system.

The clinician should refer to the corresponding manual to see the description of the measurement system specific to the selected product, before applying it to the patient. Every implant system has specific measurement characteristics. As a consequence, the surgeon must be familiar with the measurement system being utilized in order to be able to provide safety margins adjacent to any anatomical structure. Failure to respect these measures can result in permanent injury.

Each system has specific design characteristics. Combining non compatible components can lead to mechanical failure of components, damage to tissue or unsatisfactory results on the clinical or esthetic level.

Surgical PROCEDURE

Foreword

17

For all the surgical procedure, the following instructions must be observed and respected:

Make sure you have a sufficient number of implants and sterile instruments All the instruments must be sterile, complete, checked and functional, especially the measurement instruments

(calibrated according to the manufacturer’s recommendation) and the cutting instruments should not be used more than 15 times.

All the reusable products must be disinfected, cleaned and sterilized after every intervention. All the disposable components delivered non-sterile must be disinfected, cleaned and sterilized before intra-oral

use. Using a thermo-disinfector and a Class B autoclave is possible for the components out of their package, in a specific bag according to the manufacturer’s recommendations.

In case of plastic or ceramic components, always disinfect and cold sterilize with CHLORHEXIDINE. Any product delivered sterile (by gamma radiation) must not be re-sterilized and is for single use. Respect the sterile parts of the package when opening it and place its content on a sterile field. Respect the expiry date of the product. For stainless steel, the use of sodium hypochlorite is prohibited: high risk of corrosion. Respect the different combinations of materials when cleaning and decontaminating them in order not to damage

the components. Detergent and disinfectant solutions must have a neutral pH or a low alkaline level. Any preparation of the implant site with cutting instruments on contra-angle requires profuse irrigation with a

sterile saline solution (NaCI). Respect the sequence of the recommended instruments with a permanent control of the implant axis and depth

according to the planned prosthetic restoration. Make sure to minimize the thermic and surgical traumatism and to eliminate any contaminant and any infection

source which may cause a failed osseointegration or poor esthetic result. Secure the instrument and implant components handling and from the risk of fall in mouth or out of the sterile

field because of their small sizes. Make sure they are properly gripped on the instruments.

Precautions for use

18

Ø 4.2 - 4.8 - 6.5

Surgical PROCEDURE

AESTHETICA+2 IMPLANT

Applications

Aesthetica+² is a tissue level implant. Thanks to its 3 platforms, it can be placed in most of indications, especially in case of bone sites with resorbed alveolars.

Thread1,60 mm

San

dbla

sted

& e

tche

d le

ngth

Smooth & etchedneck 1.3 mm

Microthread 2,3 mm

Features

Implant Ø Ø nek L 6 mm L 8 mm L 10 mm L 12 mm L 14 mm

3.6 mm4.2 mm AIEP 36 42 080 AIEP 36 42 100 AIEP 36 42 120 AIEP 36 42 140

4.8 mm AIEP 36 48 080 AIEP 36 48 100 AIEP 36 48 120 AIEP 36 48 140

4.1 mm4.2 mm AIEP 41 42 060 AIEP 41 42 080 AIEP 41 42 100 AIEP 41 42 120 AIEP 41 42 140

4.8 mm AIEP 41 48 060 AIEP 41 48 080 AIEP 41 48 100 AIEP 41 48 120 AIEP 41 48 140

4.8 mm4.8 mm AIEP 48 48 060 AIEP 48 48 080 AIEP 48 48 100 AIEP 48 48 120 AIEP 48 48 140

6.5 mm AIEP 48 65 060 AIEP 48 65 080 AIEP 48 65 100 AIEP 48 65 120 AIEP 48 65 140

References

The implant is supplied with a healing abutment.

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3,65 mm

Airtightness & stability

The internal conical connection (Morse Taper) guarantees the airtightness and the stability of the abutment-fixture connection (S.Dibart, M. Washington,M. Fan Su, Z. Skobe). The connection has an internal octagon which allows the abutment to be orientated at the right angle.The depth of the connection and the quality of the joint between the parts guarantee a great stability and prevent the prosthetic from unscrewing.

Octagon Taper 8°

Direct implant driver

Time saving during surgery. The insertion level and the connection orientation

are easier to see. Informs about gingival height.

Connection

The Aesthetica+² implant has an internal octagonal connection with a 16 °taper.

20

Ref. ANUT 60 Ref. AIEK P 48 6

Trousse Aesthetica+2

Contient les ancillaires pour implants Ø 3.6 à 4.8.

Séquenceur spécial implants courts Aesthetica+2

Toutes les clés and Drills pour la chirurgie des implants w2

Ø6.

Surgical PROCEDURE

Exclusive microthread

Mechanical anchorage to enhance the implant stability in critical sites made up of the endo-bone neck that suffers most of masticatory forces.

A thicker microthread for a higher resistance to tear constraints.

Synchronicity with the main thread in order not to wrest bone when following it.

A unique design with 6 entries to guarantee the microthread anchorage in a precise, calibrated, similar and undamaged track.

Continuity with the microthreads, the protrusions and macrothreads for a better load distribution along the implant.

A tapered neck for a better primary stability with a cortical support

Stabilization of the implant notwithstanding a poor apical bone density.

A controlled implant insertion for a guaranteed primary stability.

First bone pit made by the min

thread

The active insertion of the microthread in

the cortical zone

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Non traumatic and active apex

A groove closer to the apex to enhance the self-tapping effect of the threads.

The threads start from the apex for a high self-tapping ability of the implant and a better apical anchorage.

A safe use in risky sites (sinus, dental nerve…).

Double threads

Fast screwing of the implant. Reduced bone heating when screwing the implant.

A central protrusion between threads

Increases surface contact with bone to enhance osseointegration. Cellular reconstruction is activated by this change of geometry.

An asymmetric thread

The thread directly influences effective surface of the implant (B.I.C).

Allows a better occlusal load distribution.

22

Surgical PROCEDURE

The stake for the realization of the implant socket is on three levels:

a calibration of the socket to obtain a good primary stability of the implant, main condition for the osteointegration.

minimum overheating to avoid all irreversible bone necrosis. The socket preparation will be made under constant external irrigation with sodium chloride at 0.9%. The critical temperature threshold is 47°C for 1mn. At 50°C, the necrosis is irreversible.

The obtainment of a calibrated socket assuring a good imperviousness.

The instruments are sorted by their stage of use. Numbers notify the main steps of each stage.

SURGICAL KIT

BE CAREFUL

It’s necessary to choose the prosthetic parts before the implant placement in order to place the implant in the correct vertical position.

WARNING

The minimum heating will be achieved with a good irrigation and with a good selection of drills with a good cutting power. It is therefore necessary to check the number of use of the drills involved in the implant socket preparation and change your drills after 10 to 15 uses.

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Ref. ANCPT_00

Surgical KIT

This surgical kit offers all the instruments necessary for the realization of the surgical protocol and the management of all the bone densities for Natea+ and Aesthetica+2 implants.

Contents:

• Point drill Ø 1.5 - 2.2• Initial drills Ø 2.2 lengths:

6, 8, 10, 12, 14 mm• Staged drills Ø 2.2 - 2.8 long & short• Staged drills Ø 2.8 - 3.3 long & short• Staged drills Ø 3.3 - 3.8 long & short• Staged drills Ø 3.8 - 4.3 long & short• Cortical drills:

- Natea+ Ø 3.6 / 3.7- Aesthetica+2 Ø 3.6 / 4.2- Natea+ / Aesthetica+2 Ø 4.1- Natea+ / Aesthetica+2 Ø 4.8 / 4.8- Aesthetica+2 Ø 4.8 / 6.5

• Taps:- Aesthetica+2 Ø 3.6- Aesthetica+2 Ø 4.1- Aesthetica+2 Ø 4.8

• Depth gauge Ø 2.2• Paralleling pins Ø 3• Paralleling implant gauge

- Natea+ - Aesthetica+2

• Implant direct keys Natea+ short, medium & long • Implant direct mandrels Natea+ short & long• Implant direct keys Aesthetica+2 short, medium & long • Implant direct mandrels Aesthetica+2 short & long• External hexagonal keys short, medium & long • External hexagonal mandrels short & long• Mandrel extension• Click wrench

• Simple and compact.• Common kit for 2 implant systems.

• A smaller size to gain space on the sterile field and in the autoclave.• Readibility of the sequences with step by step instruments presentation in order of use.

• Color coding of plugs and drills according to implant diameters..

Free additional spaces to insert the drivers and mandrels necessary to your practice.

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D4 D1D2/D3

Ø 3/3.6 Ø 3/3.6 Ø 3/3.6

Ø 3.6

Ø 3.6NP NP NP Ø 3.6 Ø 3.6

D4 D2/D3 D1

RP RP RPØ 4.1 Ø 4.1 Ø 4.1

Ø 3.5 / 4.1 Ø 3.5 / 4.1 Ø 3.5 / 4.1

21

Ø 2.2 / 2.8 Ø 2.2 / 2.8 Ø 2.2 / 2.8

Ø 2.8 / 3.3Ø 2.8 / 3.3

3 3 3

44

*

Ø 2.8 / 3.3 Ø 3.3 / 3.8 Ø 3.3 / 3.8

5 54

*

Ø 4.1

!

No length 6 mm in D4.

IMPLANTS Ø 3.6 / 4.2 lengths 8 - 10 - 12 - 14 mm

DR

ILL

DR

ILL

CO

RTI

CA

L D

RIL

L

FO

R D

1

OP

TIO

NA

L

IN S

UB

STI

TUTI

ON

DR

ILL

TAP

de 15 à 25 tr/min

25 tr/min 25 tr/min

800 tr/min 800 tr/min

800 tr/min


800 tr/min


800 tr/min

400 tr/min 400 tr/min400 tr/min 400 tr/min400 tr/min 400 tr/min

BY BONE DENSITY AND IMPLANT DIAMETER

PROTOCOL

IMPLANTS Ø 4.1 / 4.8D

rill Ø

2.2

with

sto

p12

00 tr

/min

Poi

nt d

rill Ø

1.5

- 2

.212

00 tr

/min

lengths 6 - 8 - 10 - 12 - 14 mm

25

D4 D2/D3 D1

RP WP RP WPRP WPØ 4.8 Ø 4.8 Ø 4.8

RP WP RP WP RP WP

Ø 4.2 / 4.8 Ø 4.2 / 4.8 Ø 4.2 / 4.8

Ø 4.8

Ø 3.8 / 4.3 Ø 3.8 / 4.3 Ø 3.8 / 4.3

6 6 6

*

!

No length 6 mm in D4.

25 tr/min

600 tr/min 600 tr/min 600 tr/min

400 tr/min 400 tr/min 400 tr/min400 tr/min 400 tr/min 400 tr/min

Example of insertion for a 10 mm long implant, the same as for the other lengths of implants.

IMPLANTS Ø 4.8 lengths 6 - 8 - 10 - 12 - 14 mm

* : Partial drilling to have a perfectimplant socket size to optimize the implant primary stability according to bone density.

26

5 mm

Ø 2.2

Ø 1,8 mm

Ø 1,5 mm

1 Incision

Ø 1.5 angle of cut 90°

Ø 2.2 pilot forthe next drill

Surgical PROCEDURE

Protocol

BE CAREFUL

Maintain a minimum amont of bone around the implants according to the common rules in implantology.

In the labio-lingual / or palatal direction save 1.5 mm to 2 mm of bone.

In the mesio-distal plan, save 2 mm between a natural tooth & the implant thread, or 3 mm between 2 implants threads.

Spare necessary space between the implant necks.

The width of the implant neck must be taken into account for the implant placement. Our gauges show the neck width to help place the implants with precision.

Set the motor speed at 1000 to 1200 RPM according to the bone quality and start irrigation. Visually pinpoint the implant areas.

The bone marking is made with a pointing drill of 1.5 mm diameter, more effective than a round bur. The pilot drill has a 90° point which can easily go through the cortical layer. Its upper part, with a 2.2 mm diameter, is used as a guide for the following drill.

This first drilling enables to make a socket 5mm deep and therefore leaves the possibility to correct the axis if necessary.

After use, the drill is put in a stainless steel bowl filled with sterile saline.

In case of multiple implants in the same area, proceed with the marking of sockets following the spacing rules described above.

Check the axis of the first sockets by looking at the orientation of the drill mandrel, or by inserting in the socket the thinnest side of the paralleling pin.

2 Marking OF THE BONE 3 Control OF THE SOCKET AXIS

Prepare the access to implant site via a crestal incision through the attached gingival tissue and raise a partial thickness flap.The flap should extend to allow for proper visualization of the site and adjacent tooth root when required. A partial thickness flap is made at the proposed implant site. The reflection on the flap is made large enough to visualize the adjacent roots and not into the papilla areas in an effort to preserve this tissue. In the edentulous area, the incision is made at the crest of the ridge and reflected for access. If minimally attached gingiva is an issue, avoid over reflection of the tissues into the sulcus to preserve the attachment.The crestal incision is often made towards palate for aesthetic reasons or when the quality of the attached vestibular gingiva is not enough.

Ø neck 3.9

27

lL l

L = 10

l = 10

Ø 2.2

0,80 1,

30

Choice of the length of the ø 2.2 mm drill

This drill will determine the depth and axis of the implant socket.

Lengths given for implants are corresponding to the sandblasted part without the neck of the implant

= length of implant Ll

Recommendedprotocol = 1.3 mmabove the crest

Possible burying optimisationto 0.8 mm

If a deeper insertion is needed, it is possible to place apical part of the implant in the space achieved by the tip of the drill.Supra-crestal height is then minimum 0,8 mm

4 First DRILL

BE CAREFUL

The rounded end of the implant doesn’t fit until the very bottom of the socket prepared with the drill. The socket will be slightly deeper than the implant length.This avoids any risk of apical compression and warranties the crestal anchorage in cortical area.

28

!

Surgical PROCEDURE

Insert the thinner side of the parallelism gauge(s) in the implant(s) socket(s) to evaluate the axis of emergence of the implant(s). The gauge so positioned can also control a hemorrhagic flow.

Use the diagrams p. 27, 28 and 29 to determine the succession of the drills corresponding to the diameter of the chosen implant, and to adapt the implant socket to the bone quality of the area (see page 34). This information has been transferred on a plasticized sheet included to facilitate the procedure. During the drillings,

verify that the bone bleeds. Should the opposite occur, scratch a little the bone to make it bleed. In the absence of vascularization, it’s better to close and to wait for a revascularization. Drilling speed should be between 600 and 800 RPM.

Check the depth of the socket using a graduated depth gauge dia 2.2.

The Aesthetica drills dia. 2.2 have a stop. They are available in five different lengths: 6 - 8 – 10 – 12 – 14 mm.

Perform the drilling up to the determined marking, under constant external irrigation of sodium chloride and at a speed between 1000 and 1200 RPM according to the bone quality. The drilling progression must be done

without strain. If it is the case, it indicates that bone residues are clogging the drill. An easy backward and forward motion, controlled so as to not ovalize the area, will enable a fluider progression of the drill. This does not require a reversing of the motor if it is done at the right time. If the drill is blocked, it can be removed in reverse mode.

5 Depth CONTROL

6 Control of the SOCKETS AXIS

8 Following DRILLINGS

The correction of the axis must be made at this stage when necessary.Thanks to the pointing drill, the drill Ø 2.2 will be correctly guided .

Once the depth gauge is placed in the bone, you should not see the graduation which must not appear above the bone

We advise you to collect the bone fragments resulting from each drilling in order to be able to correct any bone defect, or to improve margins of an irregular crest. The volume of the collected bone is, in most cases, enough to correct some moderate defects.

It avoids a transplant/graft and will not even require to be stabilized if the bone defect has several walls. Be careful, this bone must be preserved of any contamination and treated under the same conditions of asepsis as the implant.

7 Bone COLLECT

29

10 mm

L

1086

1

2

Stops

In a bone D2 - D3, the drills are being used at a speed between 800 and 1200 rpm depending on their diameter. In a D1 bone, we can use slower speeds between 300 and 800 rpm.The drills must work under constant irrigation.

After their use, place the drills in a stainless steel container filled with a saline solution.

Stop

Sterilizable drilling stops are available in the kit. For every drill diameter correspond a range of stop of different lengths.

The stops can be picked up directly on the drill with a contra angle. Check the alignment of the stop extremity with the graduation on the drill. Verify the stop is properly fixed on the drill.After a large number of uses, it is possible that the stops do not clip in place as easily on the drill. In this case, change the stop.

If you wish to work without the stops, you can use the marks on the drill.

Set the stop

Stop in correct position

The stops have a groove to help the insertion of the key. To remove a stop, insert the proper key in the stop groove and push the stop towards the drill extremity.

Picture.1

Implant L = 10 Stop 10 mm

(Click !)

30

Dimensioned to the diameter 2.2, they enable a check of the depth of the socket. They are graduated like the drills, i.e. every 2 mm, from 6 mm to 18 mm.

10 Depth GAUGES

Once the depth gauge is placed in the bone, you should not see the graduation which must not appear above the bone

This procedure is required for bone type D1.<b></b><m> supplies taps that only feature an active part limited to a reduced number of threads. The shape of the tap allows for just a few of the thread cutters to touch the bone in a forward rotation. Once to depth, the tapping cutters only minimally touch the bone again during the reverse rotation coming out of the bone site preparation.In most of the cases, it is advised to only thread the cortical part of the bone socket to facilitate the insertion of the implant while optimizing the primary stability of the implant.

The tap is used either with a contra-angle at a speed of 15 to 20 rpm.

Tapping

The countersink bur is used only if a part of the implant conical shoulder is located in the bone.

The countersink bur is used from 300 to 400 RPM Use the cortical drill with the same color code as the

implant diameter.

11 Cortical DRILL

This stage is required in all cases whatever the hardness of the bone is, to ensure cortical compression onto the implant neck.

Surgical PROCEDURE

Depthlimit

!

31

oka.

2.

b. c.

12 Implant INSERTION

1.

Retention area in the extremities of the 8 sides

Torque transmission area

Mark indicating that the driver is inserted. This mark should not be visible when properly inserted in the implant.

The implant can be inserted manually or with the handpiece. This procedure must be done with the greatest care so that the implant does not come in contact with any non-sterile element before insertion in the bone socket. To do so, use the screwing mandrel or manual key. After opening the tube, connect the appropriate implant driver directly to the implant without taking it out of its casing before.

12.a The implant should be taken out of its casing as follow:

Step 1 - Seat the hexagon of the mandrel or key into the implant hexagon.

Step 2 - To seize the implant, slightly rotate the mandrel or key in the implant, in clockwise direction, until the implant stops turning in its casing (a device in the casing allows to limit the implant rotation while grasping it).

Step 3- Insert the mandrel into the implant by applying light pressure so that it is retentive on the implant (5N= 500g).

a. The positioning marking is not visible any more, the mandrel is correctly seated.

b. The positioning marking is visible, the mandrel is not oriented nor inserted properly. In that case, go back to step 1

c. The positioning marking on the mandrel is visible, the mandrel is not oriented nor inserted properly. In that case, go back to step 2.

Step 4 – The mandrel is properly seated in the implant, apply light pressure counter-clockwise.

Step 5 – Take the implant to its receiving site.

Note: Be careful with the risk of fall on the floor or in the mouth when taking the implant.

32

2

1Screw with the

handpiece

Bone D1 - D2

Surgical PROCEDURE

12.b For a good positioning with the handpiece, we recommend a speed of 15 to 25 r/mn to control theinsertion of the implant. The positioning with the handpiece enables to measure the insertion torque of the implant and to evaluate its primary stability.We recommend to set the implant at 30 N.cm minimumfor a delayed loading, and higher than 40 N.cm for earlyor immediate loading. Never exceed an insertion torque of 70 N.cm.

For D1-D2 bone, it is recommended (during the screwing of an implant with a contra-angle), to finalize the screwing with the torque wrench, in order to ensure the good insertion of the implant.

Finish screwing with the torque

wrench

33

1 mm

2 mm1.3

mm

0.7 mm

7 mm8 mm9 mm10 mm11 mm

6 mm5 mm4 mm3 mm2 mm

! Do not apply excessive pressure during implant placement. Excessive overtightening may damage the internal connection and over-compress the surrounding bone, compromising osseointegration. If strong resistance is encountered during tightening, lightly unscrew the implant then insert back the implant. If there is still strong resistance, remove the implant and place it back into its titanium casing, and widen the implant site according to the drilling protocol.

- When placing the implant, align one of the hex sides on the implant manual driver or mandrel parallel to the buccal wall, which ensures that one of the flat side of the hexagon is parallel to the buccal side, ensuring preferred prosthetic abutment orientation.

12.e Removal of the driver- To remove the driver, slightly rotate it counter-clockwise before lifting it up.

12.c In the case of manual placement, the first screwing of the implant is achieved with the implant-holder key.It is finalized with the click wrench or with the torque wrench. It is recommended to check the primary stability of the implant at the end of the screwing by trying to move it.If the implant can move, its primary stability is inadequate and the osseointegration may fail; then it is better to remove it and to use an implant with a bigger diameter if the bone volume is sufficient.

Vestibular flat side

12.d Final implant placementThe angled gauge and the paralleling pins can also allow to measure supra-implant height (in option - sold separately).

34

KDR_AEST

FOR IMPLANT NECK Ø 4.2

ACI 42 47 15 H 1,5 mm

ACI 42 47 30 H 3 mm(delivered with implant)

ACI 42 47 45 H 4,5 mm


ACI 48 55 15 H 1,5 mm


ACI 48 55 45 H 4,5 mm


ACI 65 72 20 H 2 mm


ACI 65 72 45 H 4,5 mm

The conventional period to obtain a good osseointegration is:- 3 months at the mandibular,- 6 months at the maxillary due to a different bonequality.The dentist should define this period by taking into account the bone quality, the implant primary stability and the prosthetic plan.In certain cases, the dentist can decide to connect the prosthetic parts without waiting for the osseointegration.

However, the dentist must be able to analyze if theconditions of the clinical case are appropriate to an immediate loading.

Studies and scientific datas indicate that immediate loading has proven to be successful at the mandibular when the prosthesis is built on 4 implants or more linked together.Immediate loading is not recommended on a single implant.

Place the healing screw located in the cap of the tube on the implant head with the hexagonal key (Ref CCL HE 12 22) or the external hexagonal mandrel (Ref CMA HE 12 26) and tight manually (10 N.cm) or with the dynamometric torque wrench (Ref. CCC 35) for a better control.If the height of the healing screw (3mm) supplied with the implant is not adapted, other heights of screws are available in the range:

14 Osseointegration

13 Protection OF THE CONNECTION

Surgical PROCEDURE

To extract an implant, try to unscrew it with the implant driver or the implant direct key. If this solution is insufficient, please refer to the note of the extraction kit.The socket can possibly be re-implanted*:- if the patient is ready to receive a new implant,- with an implant of wider diameter, in the case thatthe placement of this implant occurs at the same time. To put another implant with a smaller diameter, it is better to wait for the complete healing of the socket.**

! IN CASE OF FAILURE

* It is important that the reasons of the failure should be analyzed before placing a new implant. ** The doctor decides whether it is necessary to use bone to fill in the socket.

EXTRACTION KIT

35

IMPRESSION TECHNIQUES

36

H 9

mm

CCL HE 12 18

CCL HE 12 18

CCL HE 12 18

CCL HE 12 22

CCL HE 12 22

CCL HE 12 22

CCL HE 12 30

CCL HE 12 30

CCL HE 12 30

CMA HE 12 22

CMA HE 12 22

CMA HE 12 22

CMA HE 12 26

CMA HE 12 26

CMA HE 12 26

Ø 4.2 APE T42

Ø 4.8 APE T48

Ø 6.5 APE T65

Ø 4.2 API 42 85

Ø 4.8 API 48 85

Ø 6.5 API 65 85

Ø 4.2 APU T42

Ø 4.8 APU T48

Ø 6.5 APU T65

Ø 4.2 ALA H42

Ø 4.8 ALA H48

Ø 6.5 ALA H65

Ø 4.2 ALA H42

Ø 4.8 ALA H48

Ø 6.5 ALA H65

Ø 4.2 ALA H42

Ø 4.8 ALA H48

Ø 6.5 ALA H65

Ø

Ø

Ø

Ø

Ø

Ø mm

8 mm

8 mm

8 mm

12 mm

12 mm

12 mm

20 mm

20 mm

20 mm

22 mm 26 mm

22 mm 26 mm

22 mm 26 mm

Technique WITH PICK-UP IMPRESSION COPING

Technique WITH POP-IN IMPRESSION COPING

Technique WITH POP-UP IMPRESSION COPING

Impression TECHNIQUES

Material required

Material required

Material required

Depending on the clinical case, you can choose to make dental impressions using 3 different techniques:

short

short

short

medium

medium

medium

long

long

long

short

short

short

long

long

long

External hexagonal keys



Pick-upimpression copings

Pop-inimpression copings

Pop-upimpression copings

Implantanalogs

Implantanalogs

Implantanalogs

External hexagonal mandrels



37

10 N.cm

After having unscrewed the healing abutment, manually screw the pick-up transfer into the implant using the hexagonal key. Do not exceed the 10 N.cm maximum tightening torque.

You can choose between 2 heights of impression coping according to your case:

• Short: height 10 mm• Long: height 13,5 mm

After making sure the transfer is positioned correctly, make the impression using an open tray and clear the head of the screw.

Once the impression has been made, unscrew the pick-up transfer using the external hexagonal key.

Remove the impression.

Screw the analog onto the transfer.

Be careful to always hold the analog and not the tray.

PROTOCOL

1 Technique with PICK-UP IMPRESSION COPING

Important Information

Advantages Precision Better accommodates divergent axes Repositioning errors are impossible (except analogue)

Ideal for multiple and single cases.

Disadvantages Long unscrewing time with the tray in place in the mouth = uncomfortable for patients with problems swallowing and vomiting

Lengthier implementation, with the removal of the splint heads and of the impression material

Restricted oral aperture contra-indicated on implantation sites in the posterior sections

Pick-up impression coping

Screw

Implant

38

10 N.cm

!

After having unscrewed the healing abutment, manually screw the pop-in transfer into the implant using the external hexagonal key. Do not exceed the 10 N.cm maximum tightening torque.

After making sure the transfer is positioned correctly, make the impression with a closed tray.

Remove then the impression, ideally in the transfer axis.

Unscrew the pop-in transfer using the external hexagonal key.

Screw the analog onto the transfer, manually orient and re-position the transfer into the impression.

PROTOCOL

2 Technique with POP-IN IMPRESSION COPING


Advantages Restricted oral opening Unscrewing after having taken out the tray = more comfortable for the patient

Ideal for single cases

Disadvantages Precision varies depending on the quality of impression materials

Possible repositioning errors The divergence between the implants should be lower than 20°

Not recommended for multi-unit cases

Pop-in impression coping

Screw

Implant

Make sure the transfer is inserted and oriented correctly into the impression.

Impression TECHNIQUES

39

!

After having unscrewed the healing abutment, manually screw the pop-up transfer into the implant using the external hexagonal key. Do not exceed the 10 N.cm maximum tightening torque.

After making sure the transfer is positioned correctly, install the clippable transfer cap.

• Orient the pink cap rib towards the transfer’s flat plane.• Clip: hear the insertion “click”.

Make the impression with a closed tray. Once the impression has been made, remove the tray,

ideally on the transfer axis. Unscrew the pop-up transfer using the external

hexagonal key. Screw the analog onto the transfer, then orient and

reposition the transfer into the impression, clipping it to the transfer cap.

PROTOCOL

3 Technique with POP-UP IMPRESSION COPING


Advantages Precision Restricted oral opening Unscrewing after having removed the tray = more comfortable for the patient

Ideal for single cases

It is possible to use the pop-in version using the screw ref. NPS VTB 16 156.

Disadvantages Possible repositioning errors Divergence between implants should be lower than 20°

Pop-in impression coping

Screw

Implant

Make sure the transfer is inserted and oriented correctly into the impression cap.

Clippabletransfer cap

40

41

PROSTHETICPROCEDURE

42

SCREWED Prosthesis: Removable prosthesis on bar

A prosthesis on short conical ConOcta abutments to make fixed prosthesis or overdentures bars.

OVERDENTUREon ball abutment

A prosthesis on O’Ring abutment.

The prosthesis on bar is achieved with the ConOcta abutment (see p. 65).

On Direct Clip abutment p. 49

On trans-screwed abutment p. 43

Prosthetic CONSTRUCTIONS

On Conocta abutment p. 59

On O’Ring abutment p. 61

Prosthetic PROCEDURE

Warning:

The tightening torques indicated in this manual should be respected to avoid risks of damaging, breaking or dysfunction of the items.

Check the proper assembling of parts in order not to cause the prosthesis to fail and to guarantee its mechanical functions.

Secure the instruments and prosthetic components handling from the risk of fall in the mouth or out of sterile field because of their small sizes. Make sure they are properly gripped on the instruments.

Certain prosthetic components are delivered sterile to be used during the surgery. ATTENTION not to re-use them.

All the disposable components delivered non-sterile must be disinfected, cleaned and sterilized before intra-oral use.

Respect the decontamination and/or sterilization rules (plastic or ceramic components cannot be sterilized in an autoclave).

In case of plastic or ceramic components, always disinfect and cold sterilize with CHLORHEXIDINE. Any product delivered sterile (by gamma radiation) must not be re-sterilized. Respect the sterile parts of the package when opening it and place the content on a sterile field. Respect the expiry date of the product. Check the proper assembling of parts in order not to cause the prosthesis to fail and to guarantee its mechanical

functions and the final esthetic result.

Foreword

CEMENTED Prosthesis:single crowns ormulti-unit bridges

A simple prosthesis technic based on the conventional dentistry: solid abutment can be considered as inlay-cores. The impression copings clipping on the abutment deliver more accurate impressions.

A prosthesis on trans-screwed abutment when more flexibility is required.

43

CEMENTED PROSTHESIS

44

5,5 mm

10 mm

10mm

10 mm

Ø 4.2 mm

Ø 4.8 mm

Ø 6.5 mm

2 mm

5,5 mm2,3 mm2 mm

Abutment height 4 5,5 7

Minimum cut abutment height 2 3,5 5

Choice of ABUTMENT

5,5 mm shaping limit

5,2 mmshaping limit

6 mmshaping limit

Ref. APS PR 48 150

shaping limit

Ref. APS PR 65 120

shaping limit

Ref. APS PR 42 100

shaping limit


You can have a set of prosthetic parts at cost price to make your tests (prosthetic trying kit).

- Solid abutments can be shortened by 2 mm height

- Standard trans-screwed abutments can be shortened as follow:

Where the abutments must be shaped, it is preferable to use trans-screwed abutments rather than solid abutments.

- Customizable abutments can be cut in respecting the limits below:

Wished angulations:- We offer angulated abutments at 15° and 20 °.- To obtain a different angulation, using a customizable abutment or a gold palladium abutment.

WARNING

The more important angulation, the more it involves an «arm» effect on the implant. The bio-mechanical balance of assembly is even better when the abutment is in the implant axis.

45

CEMENTED PROSTHESISON TRANS-SCREWED ABUTMENT

46

Use the hexagonal keyfor all parts.

! Use the long hexagonal key (Ref CCL HE 12 22 ) for the customizable abutments.

! The definitive screw should not be used for tests and fitting before the final screwing of the prosthetic part in order to preserve its elastic abilities.

3 lengths : 8 mm, 12 mm and 20 mm


Use of TRANS-SCREWED TITANIUM ABUTMENT

Use of GOLD PALLADIUM ABUTMENT

Characteristics of the gold base and the chemical composition :

1. After the healing abutment or cover screw is removed, screw the pick-up impression coping in the implant to take the impression. To check the adjustment of the impression coping on the implant, the horizontal marking of the screw must be hidden in the impression coping. (Picture 1)

2. The implant analog is connected to the impression coping to make the plaster cast. (Picture 2)You can also make your impression with the pop-in technique.

3. Selection of the abutment (straight or angulated) - the shape can be cut if necessary. (Picture 3)

4. Seat the burn-out sleeve onto the abutment to make the wax-up. (Picture 4)

5. Casting and completion of the crown.

6. The titanium abutment is seated and screwed on the implant in the mouth at a torque of 35 N.cm with the torque wrench (Ref. CCC 35). If the abutment was seated in the mouth some time before, tighten to the correct torque level at 35N.cm with the torque wrench (Ref. CCC 35) before fitting the prosthesis.

7. The prosthesis is cemented on the abutment.

LABORATORY STEPS

Gold (Au) 58,25 +/- 1 %

Platinum (Pl) 21,90 +/- 1 %

Palladium (Pd) 19,41 +/- 1 %

Irridium (Ir) 0,44 + 0,5 %/- 0 %

Hardness (HV)> 160Solidus - Liquidus : 1400 - 1490 ° CDensity: 17.5 g / cm3Thermal Expansion : 12,4 µm / m°K

Choose a fusion alloy according to standards ISO 9693, ISO 1891 and ISO 1562 compatible with a fusion point lower than 1350°C.

47

PICTURE 1. ATTACHING THE IMPRESSION COPING

PICTURE 2. ATTACHING THE IMPLANT ANALOG

PICTURE 3. ON THE PLASTER CAST

35 N.cm

Plaster cast

Definitive screwing with external hexagonal key and torque wrench at 35 N.cm.

Impression

Analog

Straight abutment

Straight abutment

Adjustment marking on the implant

4. IN THE MOUTH

Implant Implant

Impression coping

Screw

Screw

Laboratory screw

Coated screw

48

49

CEMENTED PROSTHESIS ON DIRECT CLIP ABUTMENT

50

Direct Clip abutment USE

Impression coping

Easy to fit over the solid abutment without clearing the sulcus.

Snapping area

Impression coping

Direct Clip abutment

Implant


A standard protocol using snap-fit impression copings ensures an accurate impression, which gives a reliably accurate model of the abutment.

The impression coping snaps onto a small prominence located above the abutment shoulder (see the red area on the picture below).

The burn-out sleeves are not snapped on the abutments in order to allow the technician to remove them more easily and to avoid reshaping which may compromise the prosthetic joint.

! Make sure to align the flat plane of the abutment with the interior flat plane of the impression coping.

51

PICTURE 1. IMPRESSION ON UNMODIFIED SOLID ABUTMENT

PICTURE 2. USE OF ANALOG

Tighten at 35N.cm with the external hexagonal key and the torque wrench.

PICTURE 3. PROTECTION CAP

PICTURE 4. ON PLASTER CAST

Impression coping

Impression coping

Analog

Analog

Protection cap

Burn-out sleeve

Implant

Abutment

Implant

Friction fit(not snap fit)

Click

Click

Two types of impression copings are available:

When restoring unshortened Direct Clip abutments, use the colored snap-on impression coping over the abutment in a closed tray.

When the abutment has been modified, use the white open impression coping over the abutment (see page 58).

LABORATORY STEPS

1. Choose the abutment height (4 – 5.5 – 7 mm).

2. Screw the abutment with the torque wrench (ref. CCC 35) at 35 N.cm.

3. Snap on the coping onto the abutment.Make sure to align the rib of the coping with the flat side of the abutment. Then, the impression material is spread all around the impression coping covering it completely. This technique gives an accurate impression of the implant shoulder (information is given by the coping part and not the impression material). (Picture 1)

4. Remove the impression and connect the abutment analog into the impression coping inside the impression. The snap fit guarantees the correct position of the analog. (Picture 2)

5. Fit the protection cap on the Direct Clip abutment. (Picture 3)

6. Make the plaster cast model.

7. Seat the burn-out sleeve on the analog and wax up the framework. (Picture 4)

8. Cast the wax-up.

9. Make the ceramic part of the prosthesis.

10. The crown is cemented on the abutment in the mouth after the removal of the protection cap.

Protocol ON UNMODIFIEDDIRECT CLIP ABUTMENTS

52

Protocol ON MODIFIED DIRECT CLIP ABUTMENTS


Photo credit : Dr J. BOUCHET (France)

PICTURE 1. IMPRESSION ON ABUTMENT CUT




Implant

Protocol ON MODIFIED SOLID ABUTMENTS

Impression coping

Protection cap

Plaster cast

Burn-out sleeve


Click


Implant

Protocol ON MODIFIED SOLID ABUTMENTS

Direct Clip abutment

1. Choose the abutment height (4 – 5.5 – 7 mm).

2. Adjust the Direct Clip abutment (respecting the shaping limit).

3. Place and tighten the abutment at 35 N.cm.

4. Take the impression with the white open impression coping snapped onto the abutment. Gentle pressure allows the impression coping to fit onto the abutment. Then, the impression material is injected inside and all around the impression coping until it covers completely the plastic part. (see picture 1)

5. Protection cap setting onto the abutment during the prosthesis manufacturing time.

6. Make the model with the impression. Use epoxy resin instead of plaster.

7. Seat the burn-out sleeve on the model and wax-up of the framework.

8. Cast the wax-up. (see picture 3)

9. Make the ceramic part of the prosthesis.

10. The crown is cemented after removal of the protection cap.

LABORATORY STEPS

Adjustments on Direct Clip abutments do not allow to fully enjoy the advantages of a standard impression system. We recommend applying the following technique only on single crowns for which the prosthetic adaptation is less sensitive to inaccuracy of impression copings.

Multi-unit prosthesis

A very precise adaptation of the prosthesis is necessary to avoid any tension / fracture. That is why we recommend the use of uncut Direct Clip abutments with an adapted height (the shortest possible to tolerate the axial divergences of implants). If no abutments are suitable, it is better to work with trans-screwed abutments and to make the impression on implants.

PICTURE 1. IMPRESSION ON MODIFIED ABUTMENT

53

Temporary RESTORATIONS

A provisional restoration can be fabricated on the protection cap of the Direct Clip abutment. The protection cap will be then sealed onto the solid abutment.

1. Choose the protection cap adapted to the abutment used.

2. Make some grooves on the cap to improve the retention of the temporary tooth.

3. Put a small quantity of provisional cement inside the cap and on the Direct Clip abutment.

4. Seat the cap on the Direct Clip abutment until you feel the snap on the basis of the abutment.

5. Check the correct placement of the cap and remove excess cement.

6. Make the provisional restoration on the cap.

These kits include all parts necessary for a cemented restoration on the selected height of solid abutment. This avoids any error when purchasing the parts which will have to be used together: easy to identify the parts and no risk of forgetting one of the parts.This kit is supplied without Direct Clip abutment.

Solid abutment KITS

An impression coping for impressions on non modified solid abutments

An analog

An opened impression coping for impression on modified abutment

A protection cap

A burn-out sleeve (for single or multi-unit prosthesis)

The kit includes:

54

55

ZIRCONIA PROSTHESIS ON ESTHETIBASE INTERFACE

56

4.70 mm

Ø 3 - Ø 3.4 mm

35 N.cm

35 N.cm


AbutmentCoping

Frameworks

3 - Applications

Single crowns

The thin titanium interface allows abutments or collars to be made in zirconia or pressed ceramic.

1 - Discreet

Thin titanium interface

Thin collar and low profile Invisible in the final restoration

Even more discreet

Biocompatible coating of yellow titanium nitride coating

Softer colour at the gingival margin

2 - Reliability

Titanium on titanium contact

The interface avoids a zirconia contact on titanium implant connection.

Same hardness as the implant, there is no alteration of the connection and it maintains a good seal

Zirconia abutments give an excellent aesthetic result to implant restorations. A biocompatible titanium coating on the abutment which connects with the implant ensures an excellent seal and reduce stress as the contact is titanium to titanium.

57

1. Production of the restoration.

- in pressed ceramic (coping) : use the usual technique of lost wax- in manufactured zirconia (abutment) : the model of themanufactured element will be delivered either on traditional physical model, or in digital format (scanner or CAD).

2. Sandblasting of the interface

First protect the connection and the gingival area, then sandblast the surface that will be in contact with the bonding composite with a medium grain size <50 microns under a pressure of 2 bars.

3. Clean the interface with ethanol

4. Bonding

Use a self-curing universal self-adhesive composite. Apply the composite on the titanium interface and the zirconia abutment or sleeve, then assemble the two parts. For a complete polymerization of the material follow the instructions of the product manufacturer.

5. Screw tightening

Tighten at 35 N.cm according to the diameter of the screw. Please order lab guide screws separately, do not use the same screw for lab work and final fixing in the mouth:

- short 8 mm: ref. CCL HE 12 18,- medium 12 mm: ref. CCL HE 12 22,- long 20 mm: ref. CCL HE 12 30.

Protocol

© GARCZAREK Laboratory (Sallanches - France)

© ALFONSI Laboratory (Paris - France)

© GARCZAREK Laboratory (Sallanches - France)

1. PRODUCTION OF THE RESTORATION

2. SANDBLASTING OF THE INTERFACE

3. CLEAN THE INTERFACE WITH ETHANOL

58

59

SCREWED PROSTHESIS ON CONOCTA ABUTMENT

60

1

2

10 N.cm

10 N.cm


35 N.cm


PICTURE 4. USE OF BURN-OUT SLEEVE

Impression taking

Impression coping

Analog

Analog

Burn-out sleeve

PICTURE 3. PROTECTION CAP OR TEMPORARY ABUTMENT

PICTURE 1. IMPRESSION TAKING


Impression coping

Screw

Screw

Screw

Abutment

Implant

1. Screw the ConOcta abutment onto the implant, in the mouth.

2. Screw the pick-up impression coping onto the ConOcta. To check the adjustment of the impression coping on the ConOcta abutment, the horizontal marking of the screw must be hidden in the impression coping.

3. Take the impression.

4. Unscrew the impression coping, remove the impression and connect the analog to the impression coping in the impression (the analog replicates the implant shoulder and the ConOcta abutment).

5. Place a protection cap on the ConOcta abutment. A provisional prosthesis can be fabricated on the protection cap or directly on a temporary abutment.

6. The plaster cast is made.

7. The burn-out sleeves are seated onto the analogs.

8. The prosthesis is made.

9. The prosthesis is screwed on the ConOcta in the mouth at 35 N.cm.

LABORATORY STEPS

The definitive fixing screw should not be used for the fittings and the laboratory steps. Use one guide screw ref. APV VG 20 150

Simple and precise PROTOCOL

photo credit: Dr J. BOUCHET

61

OVERDENTURE ON O’RING ABUTMENTS

62

10 N.cm

10 N.cm

35 N.cm


PICTURE 2. IMPRESSION REMOVAL


Click

Adjustment marking

PICTURE 4. ON THE PLASTER CAST

PICTURE 1. IMPRESSION TAKING

Analog

O’Ring attachment

O’Ring abutment

Impression coping

Impression coping

Impression coping

Screw

Screw

Screw

Implant

Implant

1. The pick-up impression copings are screwed onto the implants to take the impression. To check the adjustment of the impression coping on the implant, the horizontal marking of the screw must be hidden in the impression coping. (see picture 1)

2. The impression copings are unscrewed and the impression is removed. (see picture 2)

3. The analogs are screwed to the impression copings.(see picture 3)

4. Make the plaster cast model.

5. The O’Ring abutments are screwed onto the implant analogs. (see picture 4)

6. The attachments are snapped on the O’Ring abutments.

7. The overdenture is made with resin teeth placed in wax, according to the same process as a conventional complete denture with tissue support.

8. In the flask the attachments are integrated to the overdenture by casting.

9. Trying on and adjustment of the occlusion.

10. The O’Ring abutments are screwed on the implants with the internal hexagonal key or mandrel and the torque wrench (ref. CCC 35) at 35 N.cm. The prosthesis is snapped in the mouth. The soft tissue fit is checked.

LABORATORY STEPS

ANOTHER WAY TO PROCEED

It is also possible to make the impression on the ball abutment; in this case, the impression coping is not necessary, use an analog of the ball abutment.

Plaster cast

For removable prosthesisWITH BALL ABUTMENTS

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Studies & PUBLICATIONS

• Placement of implants in the mandible reconstructed with free vascularized fibula flap: comparison of 2 cases with Aesthetica+ implants - University of Cukurova (Turkey) – 2008

• Slim implants for complete denture wearers: clinical aspects and pers-pectives with OBI implants – University of Auvergne (Clermont-Ferrand - France) – 2013

• Placement of Naturactis implants in post-extraction sites – University of Madrid (Spain) - 2013

• Contribution of a hybrid synthetic and innovating product in the bone surgery and its filling Matri™ BONE with Natea and Naturall implants - Uni-versity Henry Poincarre (Nancy - France) – 2012

• Implant-supported prosthetic solution in case of small inter alveolar dis-tance on Aesthetica+ implants – Polyclinic Kiev (Ukraine) – 2009

• Histology and histomorphometry – Comparative study with the Universal and Brånemark implants – Angers Histological Laboratory (France) – 1993

• Multicentric study on the evolution of 3000 euroteknika and Nobel Bio-care implants from 1984 to 1997 – comparison of the results - Faculty of Medicine of Angers (France) – 1997

• Quantitative study on the rough surfaces of titanium dental implants and their microstructures – University Henry Poincarre (Nancy - France) – 2011

• Analysis of the surface treatment of euroteknika and competitor implants – University of Barcelona (Spain) – 2006

• Evaluation of the euroteknika implant microfiltration – University of Cata-lonia (Spain) – 2008

• Comparison between the digital planning and the final position of the implants with the teknika3D system – University of Bordeaux (France) – 2013

• Resonance frequency analysis, insertion torque and BIC of 4 implants: com-parison and correlation study in sheep - University Saint Joseph (Libanon)

• Comparison of two types of decalcified freeze-dried bone allograft in treatment of dehiscence defects around Natea implants in dogs – Univer-sity of Iran – 2011

• Comparison of the insertion and desinsertion torque of a cylindrical and a tapered implant in 3 different materials – University of Catalonia (Spain) – 2008

Downloadthe full studies

euroteknika - 726 rue du Général De Gaulle - 74700 Sallanches - FranceT : +33 (0)4 50 91 49 20 - F : +33 (0)4 50 91 98 66 - [email protected] - www.etk.dentaleuroteknika implants are medical devices of Class IIb (European Directive 93/42/CEE) comply with the standards of conformity and CE0459 marking carrier.Read carefully the instructions for use and user manual.MU_ETK_AIEP_GB_i01_2019_04_WEB

Documents

User’s guide - ETK · temporomandibular joint disorder an insufficient restorative space if a sinus lifting is needed with the implant a patient presenting risks (patient exposed